Are Iran's Current Policies and Infrastructure Supporting Healthier Food Environments?

Abstract

Background

Iran has developed a comprehensive action plan aimed at reducing premature mortality as a result of noncommunicable diseases (NCDs) by 25% by 2025.

Objective

This study aimed to describe and assess current policies and actions that public sectors in Iran are taking to create healthy food environments for prevention and management of obesity, NCDs, and their related inequalities.

Methods

The Healthy Food Environment Policy Index was the principal tool used, and interaction with key stakeholders was the main approach. Available evidence of policy implementation was collated for 47 good practice indicators across 13 policy and infrastructure support domains through searches on institutional websites and verified by government stakeholders. The final evidence report was rated by a national expert panel based on the level of implementation compared to international best practices.

Results

Overall, 89 relevant documents were identified, classified, and analyzed, comprising 5 constitutional laws or general policies, 20 parliamentary mandates, 5 national documents, 22 national regulations, and 37 national programs which were categorized into policy (n = 62) and infrastructure (n = 42) components. Notably, the highest level of evidence was observed in Leadership5 (14 documents), Provision1 (13 documents), and Provision2 (8 documents). No indicator was rated as “high” implementation, while nearly two-thirds of the indicators were rated as low or very low.

Conclusions

Despite the Iranian government's broad landscape in supporting policies that help create healthier food environments. The findings also show the need to reform all of their policies and supportive infrastructure in order to achieve significant results.

Plain Language Title

Does Iran's current policies and infrastructure support for healthier food environments?

Plain Language Summary

Similar to the global trend, Iran has witnessed a rapid surge in obesity and associated metabolic conditions, known as noncommunicable diseases (NCDs). The proliferation of obesogenic food environments, characterized by the increased availability, promotion, and relative affordability of unhealthy food options, has played a pivotal role in exacerbating this public health problem. Responding to this emergent situation, Iran has adopted comprehensive initiatives in alignment with global strategies. Providing healthier food environments stands as a cornerstone within these initiatives.

This study aims to systematically identify, introduce, classify, and assess the current nutrition policy landscape adopted by the government in Iran to create healthier food environments to reduce obesity, NCDs, and their consequent inequalities at the national level with reference to international best practices. We identified pertinent documents, including laws, regulations, and programs, through systematic searches of government websites. Subsequently, we categorized and analyzed these initiatives utilizing the Food Environment Policy Index framework, comprising 47 indicators of good practice across 2 components: policy and infrastructure. The final evidence report was rated by a national expert panel based on the level of implementation compared to international best practices.

This study's findings underscore the concerted efforts of the Iranian government in recent decades to cultivate healthier food environments. These efforts encompass diverse policies, such as reforms in industrial food composition standards, the adoption of traffic light, labeling restrictions on unhealthy food advertising, taxation on unhealthy food items, and prohibition of their provision in schools. Additionally, Iran administers a significant food-related income support program dubbed the “Electronic Food Coupon Plan” and has established various supportive infrastructures. Despite this relatively broad landscape for developing policies to create a healthier food environment, the level of implementation of none of the policies in Iran was rated “high” compared to global best practices and need to reform all of their policies and supportive infrastructure in order to achieve significant results.

Some indicators require policy formulation with stakeholder engagement, but for others addressing implementation gaps seems to be the primary need. The next phase of this project, which involves identifying and prioritizing proposed actions to modify these policies in interaction with their stakeholders, will further help identify these gaps and will provide constructive recommendations to the public sector on priority policy areas for future action.